Abstract The incidence of fragility fractures and related mortality caused by male osteoporosis (OP) are both higher than in females. Male bone health was regulated by a sophisticated network involving both androgens and estrogens. Androgens can directly promote bone formation and inhibit bone resorption through androgen receptors on osteoblasts and osteocytes. They can also be converted into estrogens via the action of aromatase and subsequently regulate bone metabolism through estrogen receptors. Declining sex hormone levels, an imbalance in the estrogen-to-androgen ratio, and the resulting disruption in bone metabolic pathways collectively contribute to the development and progression of male OP. Moreover, androgens cannot fully compensate for the bone metabolic imbalance induced by estrogen deficiency. This article reviewed research on the role and mechanism of sex hormones in male OP, as well as studies related to the risks of sex hormone therapy for OP, so as to provide the references for improving control and treatment strategies of male OP.

Objective To investigate the value of MRI of the sternal end of clavicle in bone age assessment in Chinese population,especially its applicability in the determination of criminal responsible age.Methods A total of 431 patients aged from 10.00 to 29.99 years with neck or chest MRI were retrospectively collected.According to the Schmeling grading method,the epiphyseal development of the clavicle MRI was divided into five grades.The consistency of methods was evaluated.The correlation and general descriptive analysis between MRI grades and age was analyzed.The sex difference was analyzed.Curve fitting was used to establish a nonlinear model between age and grades.Results The grades of clavicle MRI showed a significant age-related trend(Figure 2),and the correlation was 0.861(0.887 in males and 0.840 in females).Except for grade 1,there was no significant difference between males and females in other grades.The minimum age of male grade 3 was greater than 14 years old,and the minimum age of female grade 3 was greater than 16 years old.The minimum age in grade 4 and grade 5 was over 18 years old in both sexes.The best curve fitting model was cubic model for both sexes(R2=0.805 for men and 0.722 for women).Conclusion Clavicle MRI can be used for the assessment of bone age in Chinese population.Complete epiphyseal plate closure can be used as a reliable indicator for the determination of age at 18 years old,and it is expected to achieve radiation-free forensic bone age assessment.

Objective To investigate the value of MRI of the sternal end of clavicle in bone age assessment in Chinese population,especially its applicability in the determination of criminal responsible age.Methods A total of 431 patients aged from 10.00 to 29.99 years with neck or chest MRI were retrospectively collected.According to the Schmeling grading method,the epiphyseal development of the clavicle MRI was divided into five grades.The consistency of methods was evaluated.The correlation and general descriptive analysis between MRI grades and age was analyzed.The sex difference was analyzed.Curve fitting was used to establish a nonlinear model between age and grades.Results The grades of clavicle MRI showed a significant age-related trend(Figure 2),and the correlation was 0.861(0.887 in males and 0.840 in females).Except for grade 1,there was no significant difference between males and females in other grades.The minimum age of male grade 3 was greater than 14 years old,and the minimum age of female grade 3 was greater than 16 years old.The minimum age in grade 4 and grade 5 was over 18 years old in both sexes.The best curve fitting model was cubic model for both sexes(R2=0.805 for men and 0.722 for women).Conclusion Clavicle MRI can be used for the assessment of bone age in Chinese population.Complete epiphyseal plate closure can be used as a reliable indicator for the determination of age at 18 years old,and it is expected to achieve radiation-free forensic bone age assessment.

The immune checkpoint blockade (ICB) targeting on PD-1/PD-L1 has shown remarkable promise in treating cancers. However, the low response rate and frequently observed severe side effects limit its broad benefits. It is partially due to less understanding of the biological regulation of PD-L1. Here, we systematically and comprehensively summarized the regulation of PD-L1 from nuclear chromatin reorganization to extracellular presentation. In PD-L1 and PD-L2 highly expressed cancer cells, a new TAD (topologically associating domain) (chr9: 5,400,000-5,600,000) around CD274 and CD273 was discovered, which includes a reported super-enhancer to drive synchronous transcription of PD-L1 and PD-L2. The re-shaped TAD allows transcription factors such as STAT3 and IRF1 recruit to PD-L1 locus in order to guide the expression of PD-L1. After transcription, the PD-L1 is tightly regulated by miRNAs and RNA-binding proteins via the long 3'UTR. At translational level, PD-L1 protein and its membrane presentation are tightly regulated by post-translational modification such as glycosylation and ubiquitination. In addition, PD-L1 can be secreted via exosome to systematically inhibit immune response. Therefore, fully dissecting the regulation of PD-L1/PD-L2 and thoroughly detecting PD-L1/PD-L2 as well as their regulatory networks will bring more insights in ICB and ICB-based combinational therapy.

Background Organic ultraviolet (UV) filters are widely used in personal care products. So far, relevant studies on organic UV filters in indoor dust have been reported. Objective This study aims to establish a thermal desorption combined with gas chromatography-mass spectrometry (TD-GCMS) method to identify organic UV filters in indoor air collected from different indoor environments, so as to reveal the pollution levels and characteristics of organic UV filters in indoor environment. Methods Based on the standard indoor air sampling protocol, a total of 60 samples were collected from eight different kinds of indoor environments (male and female dormitory rooms, offices, labs, barber shops, printing shops, hotels, and private cars) on and nearby Minhang Campus of Shanghai Jiao Tong University from August to November, 2020. The concentrations of six common organic UV filters, including homosalate (HMS), 2-ethylhexyl salicylate (EHS), 3-(4-methylbenzylidene)-camphor (4-MBC), isoamyl 4-methoxycinnamate (IMC), octocrylene (OC), and octyl 4-methoxycinnamate (EHMC), in the air of different indoor environments were detected by TD-GCMS. Furthermore, the correlations of individual organic UV filters in different indoor environments were analysed. Results Under optimized detection conditions, the correlation coefficients of the quantitative standard curves of selected six organic UV filters were all at or above 0.997. The relative standard deviations of 1 mg·L⁻³ samples ranged from 1.74% to 7.11%, and the recoveries ranged from 67.17% to 106.5%. The relative standard deviations of 10 mg·L⁻³ samples ranged from 3.59% to 8.76%, and the recoveries ranged from 78.80% to 126.60%. The detection rates of the other five organic UV filters except IMC were all at or more than 92% in eight different kinds of indoor air. The median concentration of total organic UV filters was 75.17 ng·m⁻³, and EHS presented the highest median concentration of 28.55 ng·m⁻³. Regarding different indoor environments, the highest concentration of total organic UV filters was found in the female dormitory samples, 154.98 ng·m⁻³. The respective pair-analysis among HMS, EHMC, OC, and EHS of all indoor air samples reached a significant level of correlation (r=0.40-0.61, P<0.01). Conclusion The TD-GCMS method is satisfactory for the determination of organic UV filters in indoor air. EHS, EHMC, HMS, OC, and 4-MBC are identified in selected eight indoor environments, and they may have similar sources of pollution.

Objective:To investigate the clinicopathological features, diagnosis, differential diagnosis, and molecular alterations of malignant gastrointestinal neuroectodermal tumor (MGNET).Methods:Four cases of MGNET were collected at Fujian Provincial Hospital, from July 2013 to January 2019. H&E and immunohistochemical staining were retrospectively evaluated, together with genetic mutation analysis of EWSR1. The relevant literature was systematically reviewed.Results:There were two male and two female patients, with an age range of 34-81 (median 57) years. Tumor sizes ranged from 5-9 (median 6.8) cm. Microscopy showed diffuse and flaky growth of tumor cells, some of which were small and round. The tumor cells were arranged in solid, flaky, nested or pseudoadenoid patterns. The tumor cells were epithelioid, oval, short spindled, or small, with round or oval nuclei. The cytoplasm was eosinophilic or clear. Osteoclast-like multinucleated giant cells were scattered focally. Mitosis was about (2-10)/10 HPF. Immunohistochemically, the tumor cells were positive for S-100 protein (4/4), SOX10 (4/4), Syn (2/4), INI1 (4/4), H3K27Me3 (4/4) and vimentin (4/4). Ki-67 index was 15%-90%. Gene mutation detection confirmed EWSR1 mutation in all four cases, and C-KIT/PDGFRα genes were not mutated in two cases.Conclusions:MGNET is a rare high grade malignant soft tissue tumor. The diagnosis is based on clinicopathological, immunophenotypic, and molecular pathology features. The primary treatment for MGNET is complete surgical excision and chemotherapy; the prognosis is poor.

Objective To investigate the related factors and preventive measures of delayed gastric emptying after operation for esophageal and cardiac carcinoma.Methods A total of 45 patients with delayed gastric emptying after operation for esophageal and cardiac carcinoma were selected as observation group,and 45 patients without delayed gastric emptying after operation for esophageal and cardiac carcinoma were selected as control group.Differences in the relevant factors were compared between the two groups.Results Single factor analysis showed that older age,high body mass index,short time education,malnutrition,poor mental state,rural residence,surgical incision,blood loss,long operation time,postoperative analgesia pump application,and the large amount of fluid volume were related risks of delayed gastric emptying (P ＜ 0.05).The Logistic regression analysis showed that older age (OR =4.15,95 ％ CI:1.89 ～ 26.30),bad psychological reaction (OR =3.96,95％ CI:1.38 ～ 25.38),long operation time (OR =3.40,95％ CI:1.11 ～ 20.28) and malnutrition (OR =3.02,95％ CI:1.09 ～ 19.35) were independent factors of delayed gastric emptying.Conclusion Delayed gastric emptying is one of the common complications after operation for esophageal and cardiac carcinoma,and the influencing factors are complex.

Objective To investigate the related factors and preventive measures of delayed gastric emptying after operation for esophageal and cardiac carcinoma.Methods A total of 45 patients with delayed gastric emptying after operation for esophageal and cardiac carcinoma were selected as observation group,and 45 patients without delayed gastric emptying after operation for esophageal and cardiac carcinoma were selected as control group.Differences in the relevant factors were compared between the two groups.Results Single factor analysis showed that older age,high body mass index,short time education,malnutrition,poor mental state,rural residence,surgical incision,blood loss,long operation time,postoperative analgesia pump application,and the large amount of fluid volume were related risks of delayed gastric emptying (P ＜ 0.05).The Logistic regression analysis showed that older age (OR =4.15,95 ％ CI:1.89 ～ 26.30),bad psychological reaction (OR =3.96,95％ CI:1.38 ～ 25.38),long operation time (OR =3.40,95％ CI:1.11 ～ 20.28) and malnutrition (OR =3.02,95％ CI:1.09 ～ 19.35) were independent factors of delayed gastric emptying.Conclusion Delayed gastric emptying is one of the common complications after operation for esophageal and cardiac carcinoma,and the influencing factors are complex.

Objective To explore the effects of early ambulation and exercise with multifunctional infusion support on improving the gastrointestinal function of patients who received radical resection for esophageal cancer.Methods Totally 83 patients who received radical resection for esophageal cancer and admitted in the Department of Thoracic Surgery of Nantong Tumor Hospital from October 2015 to October 2016 were randomly and equally divided into an observation group and a control group. Patients in the observation group, on the basis of conventional surgical nursing, started early ambulation and exercise with multifunctional infusion support 24 hours after surgery, while patients in the control group received conventional nursing for esophageal cancer and started ambulation 2-3 days after surgery. Then the patients in the two groups were compared in time of anal exhaust and such gastrointestinal intolerance symptoms as abdominal distention, diarrhea, nausea, vomiting and regurgitation 72 hours after being treated with enteral nutrition.Results The patients in the observation group showed a lower incidence of abdominal distention, diarrhea, nausea, vomiting and regurgitation than the patients in the control group (P<0.05).Conclusions Early ambulation and exercise with multifunctional infusion support can help to improve the gastrointestinal function of patients who received radical resection for esophageal cancer.